Tazact (Piperacillin/Tazobactam) Dosing in Renal Impairment
For patients with renal impairment, Tazact (piperacillin/tazobactam) requires dose adjustment based on creatinine clearance, with a recommended dosage of 4g every 12 hours for severe renal impairment (CrCl <20 mL/min) and a 1g supplemental dose after hemodialysis. 1
Dosing Recommendations Based on Renal Function
Normal to Mild Impairment (CrCl >40 mL/min)
- No dosage adjustment necessary for standard dosing regimens 1
Moderate Impairment (CrCl 20-40 mL/min)
- For complicated urinary tract infections: 9g/day (3g every 8 hours) 1
- For serious systemic infections: 12g/day (4g every 8 hours) 1
Severe Impairment (CrCl <20 mL/min)
- For uncomplicated urinary tract infections: 6g/day (3g every 12 hours) 1
- For complicated urinary tract infections: 6g/day (3g every 12 hours) 1
- For serious systemic infections: 8g/day (4g every 12 hours) 1
Hemodialysis Patients
- Maximum daily dose: 6g/day (2g every 8 hours) 1
- Supplemental dose: Additional 1g dose should be administered following each dialysis session 1
- Administration timing: Drug should be given after dialysis to facilitate dosing and avoid premature removal 1
Clinical Considerations
Bolus Dose Administration
- Intravenous injection (bolus): Reconstituted solution should be injected slowly over a 3-5 minute period to help avoid vein irritation 1
- For intermittent IV infusion: Diluted solution should be infused over approximately 30 minutes 1
Monitoring Recommendations
- Regular assessment of renal function is essential, as changes in creatinine clearance are common in hospitalized patients with renal impairment 2
- Monitor for signs of acute kidney injury (AKI), particularly with higher doses (4.5g) even when frequency is reduced 3
- Serum drug concentrations should be monitored in patients with severe renal impairment to avoid toxicity 4
Important Considerations and Pitfalls
- Higher doses of piperacillin/tazobactam (4.5g) may be associated with increased risk of acute kidney injury, even when dosing frequency is reduced 3
- Patients with severe renal impairment may require hydration and dose reduction at early signs of impending AKI 3
- For patients with both renal failure and hepatic insufficiency, measurement of serum levels of piperacillin will provide additional guidance for adjusting dosage 1
- Avoid premature dose reduction in patients with acute kidney injury that may resolve within 48 hours, as this could compromise treatment efficacy 5
Special Populations
- Elderly patients (>59 years) with renal impairment are less likely to show improvement in renal function and may require more careful monitoring 2
- Patients with both hepatic and renal disease may be at higher risk for toxicity and require more intensive monitoring 1
By following these dosing recommendations and monitoring guidelines, clinicians can optimize the efficacy of Tazact while minimizing the risk of adverse effects in patients with impaired renal function.